Provider Demographics
NPI:1912171026
Name:ZIEMER, DENISE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:ZIEMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7100 PROVIMI RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-4307
Mailing Address - Country:US
Mailing Address - Phone:920-262-8908
Mailing Address - Fax:
Practice Address - Street 1:W7100 PROVIMI RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-4307
Practice Address - Country:US
Practice Address - Phone:920-262-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35010700Medicaid